Billing Integrity Analyst-Registered Nurse

HCA Healthcare•Brentwood, TN

17h•Remote

About The Position

The Billing Integrity Analyst - Registered Nurse (RN) reviews patient charges and Charge Description Master (CDM) HCPCS/CPT assignments for appropriateness using medical records, facility protocols, and other applicable documentation. The role verifies and corrects billing data for accuracy and completeness in accordance with regulatory requirements, resolves claim-processing edits or exceptions in Patient Accounting and Relay Health, applies modifiers and condition codes when appropriate, and adjusts patient account charges or balances as needed. The analyst uses clinical expertise for reviews and edits requiring RN qualifications, analyzes accounts with specialized billing requirements, and combines or splits accounts when appropriate. The analyst serves as a liaison among facility administration, the Shared Services Center, and ancillary department directors on charging, clinical documentation, and revenue opportunities. The role communicates charge-review results, develops and coordinates educational in-services, coordinates retrospective, concurrent, patient-requested, and external billing audits, and reviews denial trends for documentation and charging opportunities. It also supports facility customer-service events, education, and ongoing billing procedures. This is a work-from-home position for candidates who live and perform the work within 60 miles of an HCA Healthcare hospital in one of the listed states: FL, GA, ID, KS, KY, MO, NV, NH, NC, SC, TN, TX, UT, or VA.

Requirements

RN or other advanced nursing degree required.
Active Registered Nurse license or other advanced nursing license required; compact licenses for all states are accepted.

Nice To Haves

Healthcare experience in an acute care hospital or coding experience is preferred.
Knowledge of CPT/HCPCS codes or experience in charging or performing charge reviews.

Responsibilities

Analyze and resolve billing edits requiring RN clinical expertise that delay claims in Patient Accounting or Relay Health.
Verify and correct billing data for accuracy and completeness by reviewing medical records, facility protocols, and other applicable documentation and following regulatory requirements.
Apply modifiers and condition codes as appropriate.
Identify charging, coding, and clinical documentation issues and work with leadership and ancillary departments to resolve them.
Conduct charge audit reviews, compare billing data with documentation, and make corrections in Patient Accounting as needed.
Analyze charge-review findings and recommend improvements to facility ancillary department directors for documentation, charging flow, and accuracy.
Serve as chargemaster liaison and facilitate clinical department education on CPT codes and Revenue Codes; coordinate with ancillary departments to resolve issues.
Coordinate chargemaster updates, including activation, inactivation, and modification, with ancillary departments as necessary.
Perform assigned charge reviews, including governmental, corporate, insurance defense, patient-requested, collections, denials, focused review, SPAEs, and cosmetics reviews; research documentation, enter corrections, and communicate error trends and process-improvement opportunities.
Review regulatory and compliance communications, CMS transmittals, and Local Coverage Decisions; assess their impact on procedures and implement changes as needed.
Perform NCD/LCD coverage reviews when requested.
Participate in facility customer-service events, including FECC Committee activities, new-director onboarding, and charge education; report charging issues as appropriate.
Maintain billing education and attend required webcasts and conference calls.
Serve as a primary contact for charge-related Shared Services Center and facility inquiries and issues.
Coordinate retrospective, concurrent, patient-requested, and external billing audits and review denial trends for documentation and charging opportunities.
Provide charge-review results and develop and coordinate educational in-services for facility staff.

Benefits

Medical, prescription drug, dental, vision, behavioral health, and telemedicine services.
Wellbeing support, including free counseling and referral services.
Paid time off and paid family leave.
Long- and short-term disability coverage and leaves of absence.
401(k) plan with a 100% match on 3% to 9% of pay, based on years of service.
Employee Stock Purchase Plan.
Flexible spending accounts.
Tuition assistance, student loan assistance, certification support, dependent scholarships, and a partnership with Galen College of Nursing.
Fertility and family-building benefits and adoption assistance.
Life insurance and supplemental health protection plans.
Legal counseling, auto and home insurance, identity theft protection, and consumer discounts.
Preferred banking partnerships, retirement readiness tools, rollover support, and financial wellbeing counseling.